# Lyme Disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.05 - condition scope only, no dose · Lyme Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK431066/ · No dose - referral pathway, no medicine given in primary care · Lyme Disease - StatPearls - NCBI Bookshelf (NBK431066) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Lyme Disease - disease-level clinical article (lyme-disease-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Doxycycline — 100 mg — oral.solid ## Complete treatment card ```text LYME DISEASE Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.05 - condition scope only, no dose · Lyme Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK431066/ · No dose - referral pathway, no medicine given in primary care · Lyme Disease - StatPearls - NCBI Bookshelf (NBK431066) Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Lyme Disease - disease-level clinical article (lyme-disease-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - The bite-site rash may burn, itch, or cause no sensation at all [itching · rash] - The erythema migrans rash appears in about 70% of patients, typically 7 to 14 days after the tick bite [rash · redness] - Left untreated, the rash can expand to as much as 20 cm across over 2 to 3 weeks [rash] - Low-grade fever with muscle aches, neck stiffness, and headache marks early localized disease [fever · headache · muscle pain · neck stiffness] - Facial nerve (Bell) palsy occurs in roughly 5% of patients with early disseminated Lyme disease [paralysis] - Late Lyme arthritis brings joint pain, swelling, and stiffness, mainly affecting the knee [joint pain] - Late-stage encephalopathy causes poor concentration, memory loss, and personality change [memory loss · poor concentration] SIGNS - what you find (4) - Conjunctivitis is the most common eye finding in early disseminated Lyme disease - A slow-growing, painless, red-bluish plaque or nodule on the earlobe or breast suggests borrelial lymphocytoma [plaques] - Bluish-red discoloration and swelling on the backs of the hands and feet, mainly in older women, suggests acrodermatitis chronica atrophicans - Lyme carditis can present with arrhythmia or transient heart block [arrhythmia · heart block] TESTS (6) - Serologic testing starts with a sensitive screening immunoassay before any confirmatory test - A positive or equivocal screening test is followed by a Western blot for confirmation - The IgM immunoblot counts as positive with at least 2 of 3 bands, but only in the first 30 days of illness; the IgG immunoblot needs 5 to 10 positive bands and can be read at any time - Serologic testing is over 80% sensitive once neurologic or cardiac features are present - Hospital admission for continuous ECG monitoring is advised when PR interval prolongation exceeds 300 milliseconds - Serum antibody testing is favored over PCR or culture of joint fluid when Lyme arthritis is suspected IF NOT THIS - what else fits (4) - Southern tick-associated rash illness produces a similar rash and is a key mimic of erythema migrans - Viral meningitis and multiple sclerosis are considered when neuroborreliosis is suspected - Gout, septic arthritis, and early rheumatoid arthritis are differentials for Lyme arthritis - Post-treatment Lyme disease syndrome overlaps with long COVID, depression, hypothyroidism, and fibromyalgia Source StatPearls "Lyme Disease" - disease-level clinical article Status traced to the source above Rx: Main treatment | Single-dose prophylaxis after a qualifying tick bite MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Tick-borne infection carried by Ixodes ticks, which are not established in Egypt - this is not a locally-acquired disease. If a patient returns from a Lyme-endemic area (Europe/North America) with a tick bite and the characteristic expanding rash, empiric doxycycline is the standard treatment and a GP could reasonably start it while arranging specialist referral. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Tick-borne infection carried by Ixodes ticks, which are not established in Egypt - this is not a locally-acquired disease. If a patient returns from a Lyme-endemic area (Europe/North America) with a tick bite and the characteristic expanding rash, empiric doxycycline is the standard treatment and a GP could reasonably start it while arranging specialist referral. Caution RED FLAG - Acute Lyme carditis presenting with complete atrioventricular heart block, syncope, or myocarditis: assess urgently and refer. Not endemic in Egypt. Relevant to a returning traveller or an imported case; consider the travel history before anything else. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Cardiac (Lyme carditis) and neurologic manifestations require hospital admission or specialist management rather than routine outpatient referral. RED FLAG - Erythema migrans (an expanding target-like rash) after a tick bite abroad means starting treatment without waiting for serology, and facial palsy, cardiac conduction abnormalities, or arthritis suggesting disseminated disease needs referral. SINGLE-DOSE PROPHYLAXIS AFTER A QUALIFYING TICK BITE 2. DOXYCYCLINE [1st line] Adult 200 mg by mouth once, as a single dose - single dose Peds 4.4 mg/kg/dose [child max 200 mg] (Children take 4.4 mg/kg as a single dose, never more than 200 mg. A single dose is used at any age.) 3kg -> 13.2 mg/dose 4kg -> 17.6 mg/dose 5kg -> 22 mg/dose 6kg -> 26.4 mg/dose 7kg -> 30.8 mg/dose 8kg -> 35.2 mg/dose 9kg -> 39.6 mg/dose 10kg -> 44 mg/dose 11kg -> 48.4 mg/dose 12kg -> 52.8 mg/dose 13kg -> 57.2 mg/dose 14kg -> 61.6 mg/dose 15kg -> 66 mg/dose 16kg -> 70.4 mg/dose 17kg -> 74.8 mg/dose 18kg -> 79.2 mg/dose 19kg -> 83.6 mg/dose 20kg -> 88 mg/dose 21kg -> 92.4 mg/dose 22kg -> 96.8 mg/dose 23kg -> 101.2 mg/dose 24kg -> 105.6 mg/dose 25kg -> 110 mg/dose 26kg -> 114.4 mg/dose 27kg -> 118.8 mg/dose 28kg -> 123.2 mg/dose 29kg -> 127.6 mg/dose 30kg -> 132 mg/dose 31kg -> 136.4 mg/dose 32kg -> 140.8 mg/dose 33kg -> 145.2 mg/dose 34kg -> 149.6 mg/dose 35kg -> 154 mg/dose 36kg -> 158.4 mg/dose 37kg -> 162.8 mg/dose 38kg -> 167.2 mg/dose 39kg -> 171.6 mg/dose 40kg -> 176 mg/dose 41kg -> 180.4 mg/dose 42kg -> 184.8 mg/dose 43kg -> 189.2 mg/dose 44kg -> 193.6 mg/dose 45kg -> 198 mg/dose 46kg -> 200 mg/dose (capped) 47kg -> 200 mg/dose (capped) 48kg -> 200 mg/dose (capped) 49kg -> 200 mg/dose (capped) 50kg -> 200 mg/dose (capped) Source Lyme Disease - StatPearls - NCBI Bookshelf (NBK431066) Why Egypt is not a Lyme country, so the single dose is for the patient who comes back from travel with a tick bite and no symptoms yet. One dose given early prevents the illness, which is why it belongs in primary care rather than behind a referral. Caution This is prophylaxis only for a bite that meets the article's conditions - the tick identified as the right species, or the bite in a highly endemic area, or the tick attached for a prolonged period. A bite that meets none of them does not need an antibiotic. It is for the patient who has no symptoms. Anyone with the spreading rash, fever or joint pain needs a full treatment course, not one tablet. Take it with a full glass of water, sitting or standing, and not immediately before lying down, or it can burn the gullet. Warn about sunburn - doxycycline makes the skin far more sensitive to sun, which matters in Egypt. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)